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Sleep Initiation and Maintenance Disorders: HELP
Articles by Donald L. Bliwise
Based on 14 articles published since 2008
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Between 2008 and 2019, D. L. Bliwise wrote the following 14 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
1 Editorial Cataloging nocturia (circa 2014). 2014

Bliwise, Donald L. ·Emory University School of Medicine, Atlanta, GA. ·Sleep · Pubmed #24899754.

ABSTRACT: -- No abstract --

2 Editorial The pit (of sleeplessness) and the pendulum (of regulation). 2010

Bliwise, Donald L. · ·Sleep Med · Pubmed #19945339.

ABSTRACT: -- No abstract --

3 Review Sleep and Nocturia in Older Adults. 2018

Vaughan, Camille P / Bliwise, Donald L. ·Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Medical Center, Decatur, GA, USA; Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, GA, USA. Electronic address: camille.vaughan@emory.edu. · Program in Sleep, Aging and Chronobiology, Department of Neurology, Emory University, 12 Executive Park Drive, Atlanta, GA 30329, USA. ·Sleep Med Clin · Pubmed #29412977.

ABSTRACT: Older adults frequently experience nocturia and sleep disturbance concurrently, and problems with sleep resulting from nocturia are a major factor accompanying the bother associated with nocturia. A multicomponent treatment strategy is usually warranted. Initial treatment includes lifestyle modification and behavioral treatment with consideration of pelvic floor muscle exercise-based therapy. Early evidence suggests that behavioral treatment results in similar nocturia reductions compared with the most frequently used drug therapies. Providers should consider formal sleep evaluation if initial treatment strategies for nocturia do not result in significant improvement, because specific sleep disorders may predispose to nocturia.

4 Review Autonomic activation in insomnia: the case for acupuncture. 2011

Huang, Wei / Kutner, Nancy / Bliwise, Donald L. ·Atlanta VA Medical Center, Atlanta, GA, USA. ·J Clin Sleep Med · Pubmed #21344045.

ABSTRACT: Current conceptualizations of the biological basis for insomnia typically invoke central nervous system and/or autonomic nervous system arousal. Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness. We illustrate principles of acupuncture intervention applied to cases of otherwise intractable insomnia that document successful application of this component of Traditional Chinese Medicine to the treatment of poor sleep. Our review indicates the necessity for further research in the relationship between the effects of acupuncture on insomnia and autonomic regulation, which might guide better selective use of this treatment modality for insomnia.

5 Review The effect of nocturia on sleep. 2011

Ancoli-Israel, Sonia / Bliwise, Donald L / Nørgaard, Jens Peter. ·Department of Psychiatry, University of California, San Diego, San Diego, CA 92093-0733, USA. sancoliisrael@ucsd.edu ·Sleep Med Rev · Pubmed #20965130.

ABSTRACT: Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

6 Review A systematic review of the effects of acupuncture in treating insomnia. 2009

Huang, Wei / Kutner, Nancy / Bliwise, Donald L. ·VA Medical Center at Atlanta, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, 1670 Clairmont Road, Decatur, GA 30033, USA. wei.huang@emoryhealthcare.org ·Sleep Med Rev · Pubmed #19097814.

ABSTRACT: To examine the extent to which research supports the use of acupuncture in treating insomnia, a systematic review was conducted that included not only clinical trials, but also case series in both English and Chinese literature. Thirty studies were included in the review, 93% of which showed positive treatment effects of acupuncture in improving various aspects of sleep. Although acupuncture has been demonstrated to be safe and holds great potential to be an effective treatment modality for insomnia, the evidence is limited by the quality of these studies and mixed results from those with sham (or unreal treatment) controls. Of the thirty studies, twelve were clinical trials with only three double-blinded. Only five used sham controls, and of these, four showed statistically significant differences favoring real treatments; however, none evaluated the adequacy of sham assignment. Three studies used actigraphy or polysomnography as objective outcome measures. The considerable heterogeneity of acupuncture techniques and acupoint selections among all studies made the results difficult to compare and integrate. High-quality randomized clinical trials of acupuncture in treating insomnia, with proper sham and blinding procedures will be required in the future. This review highlights aspects of acupuncture treatments important to guide future research and clinical practice.

7 Clinical Trial Insomnia on dialysis nights: the beneficial effects of cool dialysate. 2008

Parker, Kathy P / Bailey, James L / Rye, David B / Bliwise, Donald L / Van Someren, Eus J W. ·Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA. kpark04@emory.edu ·J Nephrol · Pubmed #18446736.

ABSTRACT: BACKGROUND: Hemodialysis (HD) induces physiological changes that may affect the ability to dissipate heat and adversely affect sleep on the nights following treatment. We studied the effects of altering dialysate temperature on polysomnographic measures of nocturnal sleep and the time course of proximal skin temperature. METHODS: The sample included seven stable HD patients. The three-phase randomized trial was conducted in a research facility. After one acclimatization night, subjects were readmitted in the evening on two additional occasions for 42 hours and received HD the next morning in the warm condition (dialysate--37 degrees C) and cool condition (dialysate--35 degrees C) in random order. Continuous proximal skin temperature (axillary, Tax) and polysomnographic measures of sleep were recorded the nights before and after HD was administered. RESULTS: Highly significant findings included that the course of Tax was markedly affected by the interaction of time and condition. In addition, there was a greater drop of Tax in the early morning following the warm condition than during the baseline nights or in the cool condition. Logistic regression indicated that the odds for the occurrence of sleep and its deeper stages were strongly and positively associated with Tax. Time of sleep onset was earlier in the cool condition (p = 0.032) with trends toward longer total sleep times (p = 0.090) and shorter REM latencies (p = 0.088). CONCLUSIONS: These observations suggest that the use of cool dialysate during HD may improve nocturnal sleep the night following treatment by decreasing sympathetic activation and sustaining the normally elevated nocturnal skin temperature until later into the morning hours.

8 Article Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. 2017

Fung, Constance H / Vaughan, Camille P / Markland, Alayne D / Huang, Alison J / Mitchell, Michael N / Bliwise, Donald L / Ancoli-Israel, Sonia / Redline, Susan / Alessi, Cathy A / Stone, Katie. ·Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California. · Department of Medicine, University of California Los Angeles, Los Angeles, California. · Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama. · Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. · Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, University of California San Francisco, San Francisco, California. · Sleep Program, Emory University School of Medicine, Atlanta, Georgia. · Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California. · Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts. · California Pacific Medical Center, San Francisco, California. ·J Am Geriatr Soc · Pubmed #28914959.

ABSTRACT: OBJECTIVES: (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING: Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS: Community-dwelling women aged ≥80 years. MEASUREMENTS: Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS: Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R CONCLUSIONS: Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.

9 Article Validated Measures of Insomnia, Function, Sleepiness, and Nasal Obstruction in a CPAP Alternatives Clinic Population. 2017

Lam, Austin S / Collop, Nancy A / Bliwise, Donald L / Dedhia, Raj C. ·Emory University School of Medicine, Atlanta, Georgia. · Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia. · Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia. · Department of Neurology, Emory University School of Medicine, Atlanta, Georgia. · Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia. ·J Clin Sleep Med · Pubmed #28633723.

ABSTRACT: STUDY OBJECTIVES: Although efficacious in the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) can be difficult to tolerate, with long-term adherence rates approaching 50%. CPAP alternatives clinics specialize in the evaluation and treatment of CPAP-intolerant patients; yet this population has not been studied in the literature. To better understand these patients, we sought to assess insomnia, sleep-related functional status, sleepiness, and nasal obstruction, utilizing data from validated instruments. METHODS: After approval from the Emory University Institutional Review Board, a retrospective chart review was performed from September 2015 to September 2016 of new patient visits at the Emory CPAP alternatives clinic. Patient demographics and responses were recorded from the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), Epworth Sleepiness Scale, and Nasal Obstruction Symptom Evaluation questionnaires. RESULTS: A total of 172 patients were included, with 81% having moderate-severe OSA. Most of the patients demonstrated moderate-severe clinical insomnia and at least moderate nasal obstruction. FOSQ-10 scores indicated sleep-related functional impairment in 88%. However, most patients did not demonstrate excessive daytime sleepiness. CONCLUSION: This patient population demonstrates significant symptomatology and functional impairment. Because of the severity of their OSA, they are at increased risk of complications. In order to mitigate the detrimental effects of OSA, these significantly impacted patients should be identified and encouraged to seek CPAP alternatives clinics that specialize in the treatment of this population.

10 Article Short time to first void is associated with lower whole-night sleep quality in nocturia patients. 2015

Bliwise, Donald L / Holm-Larsen, Tove / Goble, Sandra / Nørgaard, Jens Peter. ·Program in Sleep Medicine, Emory University School of Medicine, Atlanta, GA. · Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark. · Global Research and Development, Ferring Pharmaceuticals, Copenhagen, Denmark. ·J Clin Sleep Med · Pubmed #25325578.

ABSTRACT: STUDY OBJECTIVE: To examine associations between diary-based reports of the time to first void and a commonly used measure of sleep across the entire night, the Pittsburgh Sleep Quality Index (PSQI). DESIGN AND SETTING: Data from the Baseline phase of a large, multi-site, US-based, randomized clinical trial of a nocturia medication were analyzed. We examined age-adjusted associations between time to first void as reported in a 3-day diary and PSQI Global and individual subscale scores. PATIENTS: 757 patients with nocturia completing Baseline measurements. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Using quartile analysis, higher scores indicating poorer sleep on all PSQI scales were associated (p's ≤ 0.05) with short time to first void durations. Among individuals in the lowest quartile of time to first void (< 1.17 hours), the odds ratio (OR) of a PSQI Global score > 5 was nearly 3 times (2.96; 95% CI 1.75-5.01) that of those in the highest quartile (> 2.50 h). Shorter time to first void was associated with lower sleep quality, shorter sleep duration, poorer sleep efficiency, and greater daytime dysfunction. CONCLUSIONS: Time to first void may serve as a valuable adjunctive, self-report measure for characterizing poor sleep among populations with nocturia.

11 Article Nocturia reported in nightly sleep diaries: common occurrence with significant implications? 2014

Bliwise, Donald L / Friedman, Leah / Hernandez, Beatriz / Zeitzer, Jamie M / Kushida, Clete A / Yesavage, Jerome A. ·Department of Neurology, Emory University School of Medicine. · Stanford University School of Medicine. ·Health Psychol · Pubmed #24245840.

ABSTRACT: OBJECTIVE: Nocturia (nocturnal awakenings associated with urination) is so common a nocturnal behavior that its association with poor sleep is often overlooked. This study examined nocturia and its potential role in poor sleep by examining reported nightly awakenings and associated bathroom trips. METHODS: Sleep diaries were kept by 119 adults with poor sleep for intervals up to 14 days. Diaries collected data on nightly number of awakenings and nightly number of bathroom trips. The proportion of nocturnal awakenings accompanied by voiding for each night was calculated and averaged within each individual. Demographics and various health conditions were examined in relation to this measure. RESULTS: Nocturia was defined when at least two-thirds of all awakenings were associated with nocturnal voiding. Absence of nocturia was defined when less than one-third of awakenings were associated with voiding. Remaining cases were defined as having possible nocturia. Estimates of nocturia derived from prestudy screening were related to nocturia as defined by sleep diaries. Neither gender nor sleep apnea was associated with nocturia. Unadjusted analyses indicated that individuals with nocturia were more likely to have arthritis and attribute their nighttime awakenings to urge to void than individuals without nocturia. CONCLUSIONS: Nocturia is an exceedingly common phenomenon and may be associated with multiple morbidities. RESULTS are discussed in terms of causality and whether the perceived urge to void precedes or follows nocturnal awakening. Correlates of nocturia have important implications, because they can inform interventions that target brain (e.g., cognitive-behavioral treatments for insomnia, sedative/hypnotic medications) versus bladder (e.g., bladder control exercises, medications affecting urine production or urgency).

12 Article Nocturia compounds nocturnal wakefulness in older individuals with insomnia. 2013

Zeitzer, Jamie M / Bliwise, Donald L / Hernandez, Beatriz / Friedman, Leah / Yesavage, Jerome A. ·Department of Psychiatry, Stanford University, Palo Alto CA 94304, USA. jzeitzer@stanford.edu ·J Clin Sleep Med · Pubmed #23493881.

ABSTRACT: STUDY OBJECTIVES: To determine the impact of nocturia on objective measures of sleep in older individuals with insomnia. METHODS: The sleep and toileting patterns of a group of community-dwelling older men (n = 55, aged 64.3 ± 7.52 years) and women (n = 92, aged 62.5 ± 6.73 years) with insomnia were studied for two weeks using sleep logs and one week using actigraphy. The relationships between nocturia and various sleep parameters were analyzed with ANOVA and linear regression. RESULTS: More than half (54.2% ± 39.9%) of all log-reported nocturnal awakenings were associated with nocturia. A greater number of trips to the toilet was associated with worse log-reported restedness (p < 0.01) and sleep efficiency (p < 0.001), as well as increases in actigraph-derived measures of the number and length of nocturnal wake bouts (p < 0.001) and wake after sleep onset (p < 0.001). Actigraph-determined wake bouts were 11.5% ± 23.5% longer on nights on which there was a trip to the toilet and wake after sleep onset was 20.8% ± 33.0% longer during these nights. CONCLUSIONS: Nocturia is a common occurrence in older individuals with insomnia and is significantly associated with increased nocturnal wakefulness and decreased subjective restedness after sleep.

13 Article Self-rated sleep characteristics and bother from nocturia. 2012

Vaughan, C P / Eisenstein, R / Bliwise, D L / Endeshaw, Y K / Nagamia, Z J / Wolf, R A / Johnson, T M. ·Birmingham/Atlanta GRECC, Atlanta VA Medical Center, Decatur, GA, USA. epedigo@emory.edu ·Int J Clin Pract · Pubmed #22356249.

ABSTRACT: PURPOSE: The aim of this study was to evaluate if men with varying degrees of bother from a similar number of nocturia episodes differ with respect to self-rated sleep characteristics and fatigue. MATERIALS AND METHODS: As part of the baseline assessments during a nocturia treatment trial, 55 participants reported frequency and bother of nocturia using the AUA Symptom Inventory and completed 7-day sleep diaries prior to treatment. Participants who reported moderate nocturia (either two or three episodes nightly) were further grouped into categories of LOW (nocturia is no problem or a very small problem) or HIGH bother (nocturia is a big problem). Information from the participant completed sleep diaries was abstracted, including information on daytime napping, total sleep time, mean time needed to return to sleep, nighttime ratings of fatigue, and daytime ratings of fatigue. RESULTS: Of the 55 individuals who completed the pilot study, 24 study participants reported two or three episodes of nocturia and had either HIGH (n = 11) or LOW (n = 13) bother. Participants categorised with HIGH bother were significantly more likely than those with LOW bother to report difficulty initiating sleep (47.7 ± 34.4 vs. 23.5 ± 13.6 min, p = 0.05), difficulty returning to sleep after an awakening (28.9 ± 16.1 vs. 15.4 ± 9.6 min, p = 0.03) and greater morning fatigue (3.3 ± 0.7 vs. 2.5 ± 1.0, p = 0.04 on a 7-point scale). CONCLUSIONS: Since bother related to nocturia is linked to sleep quality, interventions targeting fatigue and sleep maintenance may provide useful targets in the management of nocturia in men.

14 Article Nocturia and disturbed sleep in the elderly. 2009

Bliwise, Donald L / Foley, Daniel J / Vitiello, Michael V / Ansari, Farzaneh Pour / Ancoli-Israel, Sonia / Walsh, James K. ·Program in Sleep, Aging and Chronobiology, Emory University School of Medicine, Wesley Woods Center, Atlanta, GA 30329, USA. dbliwis@emory.edu ·Sleep Med · Pubmed #18703381.

ABSTRACT: BACKGROUND: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. METHODS: We examined the prevalence of nocturia and examined its role in self-reported insomnia and poor sleep quality in a survey of 1424 elderly individuals, ages 55-84. Data were derived from a 2003 National Sleep Foundation telephone poll conducted in a representative sample of the United States population who underwent a 20-min structured telephone interview. Nocturia was not a focus of the survey, but data collected relevant to this topic allowed examination of relevant associations with sleep. RESULTS: When inquired about in a checklist format, nocturia was listed as a self-perceived cause of nocturnal sleep "every night or almost every night" by 53% of the sample, which was over four times as frequently as the next most often cited cause of poor sleep, pain (12%). In multivariate logistic models, nocturia was an independent predictor both of self-reported insomnia (75% increased risk) and reduced sleep quality (71% increased risk), along with female gender and other medical and psychiatric conditions. CONCLUSIONS: Nocturia is a frequently overlooked cause of poor sleep in the elderly and may warrant targeted interventions.